Empty Sella Syndrome: Symptoms, Causes, Treatments - WebMD

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Within your skull, there’s a small, bony nook at the base of your brain that holds and protects your pituitary gland (which controls how hormones work in your body). This tiny structure is called the sella turcica.

In a small number of people, the sella turcica is shaped in such a way that spinal fluid can leak into it. The buildup of spinal fluid squashes the pituitary gland flat, so it looks like your sella turcica is empty. This condition is known as primary empty sella syndrome (ESS) and can also be seen in pseudotumor cerebrii.

Your pituitary gland also can be flattened or small because you’ve had surgery or radiation for a tumor or a serious head injury. This is called secondary empty sella syndrome.

Neither type affects your overall health, and both are rare. Doctors usually only find ESS when they’re looking for the cause of other problems.

Women are more likely to have ESS than men. It’s also more common among people who are obese or have high blood pressure.

Symptoms

Most people who have ESS don’t have any signs of it. Some doctors think that fewer than 1% of people who have it have symptoms or problems because of it.

When people do have symptoms, these are the most common:

• Headaches
• High blood pressure
• Fatigue
• Impotence (in men)
• Low sex drive
• No menstrual periods or irregular ones (in women)
• Infertility

Less common ones can include:

• A feeling of pressure inside your skull
• Spinal fluid leaking from your nose
• Swelling in your eyes
• Blurry vision

Diagnosis

If you have symptoms of ESS, your doctor will ask about your medical history and recommend an imaging test of your brain to see if your sella turcica looks empty. These scans might include:

• Magnetic resonance imaging (MRI) scan: This uses powerful magnets and radio waves to make detailed pictures of the inside of your brain.
• Computerized tomography (CT) scan: Your doctor will take X-rays of your head from several angles and put them together to make a more complete picture.

Treatment

If you have ESS but it’s not causing any issues for you, you probably won’t need treatment.

If you do have symptoms, your doctor may offer:

• Medicine. If your pituitary gland isn’t putting out the right amounts of hormones, your doctor may give you drugs to help fix that.
• Surgery. If spinal fluid is leaking from your nose, a doctor may do surgery to keep that from happening.

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